| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,913 |
1,912 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,377 |
2,374 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,350 |
1,346 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,178 |
2,175 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,419 |
1,417 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,405 |
2,394 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
521 |
520 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
47 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
435 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
290 |
$2K |
| D1120 |
Prophylaxis - child |
114 |
114 |
$2K |
| D2140 |
|
14 |
14 |
$654.24 |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$633.26 |
| D1999 |
|
208 |
190 |
$0.00 |